Why saying no is a good thing

5 Reasons Saying “No” To Your Kids Is A Good Thing

Parents have a hard time saying no to their children because they want their child to be happy and to have positive experiences. They are concerned that if they say no, it will lead to unhappiness, defiance, a lack of creativity and a decreased sense of self-esteem in their child. Today, more than ever, it is important for parents to be comfortable with saying “no” to their children. Saying no without frustration/anger and following through with what you say let’s a child know that you care about them and that you want them to be safe. In other words, saying no is a good thing.

Here are five additional reasons why saying no to your child can be a good thing:Why saying no is a good thing

  1. Children want you to say no. They actually like structure and limit setting by parents and typically respond better to parents that can provide consistency and who hold them accountable for their actions.
  2. Saying “no” provides teachable moments. It allows your child to learn that they cannot always have what they want.
  3. It teaches children to delay gratification and to learn how to be patient.
  4. It teaches them to learn how to handle disappointment and helps them to learn how to work through disappointment through problem solving other solutions.
  5. It also teaches them how to respect their parents and other adults, as well as allows them to prepare for being in the “real world.”

Need help getting your child’s behavior under control? Click here to read a blog on 1-2-3 Magic Behavioral Principles!

when to specialize in a sport

Should Your Child Specialize in a Sport?

In a push to help their children become the best – insert sport here – player, many parents are quick to sign them up for year round travel teams and private training sessions. The question is, what is the best age to begin this specialization and professionalization of sport? If we were to ask world-renowned sports orthopedic surgeon Dr. James Andrews, I bet he would say much later than we currently are.

Why shouldn’t young children specialize in a sport?when to specialize in a sport

Dr. James Andrews is a strong proponent of giving young athletes time off to recover, stating “their kid needs at least two months off each year to recover from a specific sport. Preferably, three to four months.” Dr. Andrews goes on to state that there is an epidemic of adult-type overuse injuries, such as rotator cuff injuries and UCL tears (the injury that requires Tommy John surgery) in youth athletes across America, with children as young as 12 years old comprising almost half his patients. So while parents and coaches are pushing for younger and younger sport specialization, I’m here to ask you to please diversify your children’s after school activities and allow for proper rest.

How do you allow your child ample time to recover from sports?

While this can mean allowing a 2-4 month break from all sports, the emphasis here is on taking a break from each type of sport. For example, sports that focus on repetitive overhead movements include baseball and swimming, ones that require short bursts of explosive energy include basketball and football, and those that involve a combination of endurance and explosive bursts include sports such as soccer and hockey. Each of these types of sports has their own overuse injuries associated with them, so it is important to take a break from the whole sport subset rather than going from, say swimming to baseball. A great way to limit overuse injuries is to follow the seasonal sports, allowing for adequate time to rest between each sport and also during one season.

Won’t a break hinder my child’s progress in his/her chosen sport?

You may be worried that the lack of practice may hinder your child’s skill set, but many dual sport athletes have gone on to say that aspects of one sport-specific training have had a significant impact on their performance in an entirely different sport. For example, a football wide receiver may be able to draw from footwork gained during a previous soccer season. We can look to the NFL for living proof of this. Russell Wilson of the Seattle Seahawks was a dual sport athlete at North Carolina State, playing football and baseball, even signing to a minor league contract prior to the NFL. Brandon Weedon of the Dallas Cowboys pursued a career in baseball, prior to enrolling at Oklahoma State and leading the Sooners to the 2012 Fiesta Bowl. Even LeBron James was a two-sport athlete prior to signing with the Cleveland Cavaliers the first time. So let’s stopping training our kids to become the next Tiger Woods, only to have them become one of Dr. Andrews’ statistics, and allow their growing bodies to rest as needed and diversify their skill sets along the way.

As a parent, you are your child’s biggest advocate. Now that you know the true dangers of early sport specialization please educate coaches and give your children the rest they need. For further information on overuse injury prevention in children, please contact our Pediatric Physical Therapists at North Shore Pediatric Therapy.

oppositional defiant disorder

Top Warning Signs for Oppositional Defiant Disorder (ODD)

How can a child’s irritable mood, lack of awareness into how their behavior impacts others, and resistance towards engagement in unfavorable tasks be differentiated from age-appropriate/typical behavior to something more serious, like a clinical diagnosis of Oppositional Defiant Disorder (ODD).

What is ODD?

According to the DSM-V, a diagnosis of Oppositional Defiant Disorder (ODD) is characterized as “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from these categories.” The DSM-V also outlines that to qualify for a diagnosis of ODD, the individual must demonstrate these symptoms during an interaction with at least one other person other than a sibling.

Warning signs for ODD include:

  • Often loses temper
  • Negative outlook/mood
  • Defiance
  • Disobedience
  • Hostility towards authority figures
  • Regular temper tantrums
  • Blames others for his mistakes or misbehavior
  • Does not comply with rules of tasks assigned by adult
  • Spiteful or vindictive nature
  • Enjoys annoying others and is easily annoyed themselves

Treatment for ODD includes clinical intervention and potential medication management to address related symptoms such as mood dysregulation or impulse control as resonate of an ADHD diagnosis. Parent training for education on how to effectively discipline and avoid power struggles, individual/family therapy, and cognitive behavioral therapy are all treatment modalities to holistically treat ODD.


articulation norms

Articulation Norms

Children acquire language in a typical pattern – first making isolated sounds, next syllables, followed by words, and eventually children begin to combine words into sentences to express their wants and needs. During this time of language acquisition, children are rapidly learning new sounds. Parents will notice that children don’t yet speak in adult-like dialogue and much of what a child is saying may be unintelligible to unfamiliar listeners. Rapid speech-language development can leave parents wondering, is my child developing appropriately?

The chart below represents ages that most children will acquire certain sounds. Some children will begin to use sounds earlier, and some later.

Articulation Norms by Age:


Age Speech Sound Intelligibility Warning Signs
3-3 ½ m, n, h, w, p, t, k, b, d, g, f, y (yes), tw- (twin), kw- (quick), and most vowel sounds Approx. 75% intelligible to adults Child should be understood by parents, caregivers. Should correctly produce vowels and /p, b, m, w/ sounds. Child should repeat/clarify without frustration.
4- 4 ½ v, j (jump or giant), gl- (glow) Approx. 100% intelligible to adults, may still have errors Child should be understood by familiar and unfamiliar listeners. Should correctly produce /t, d, k, f, g/ sounds. Child should repeat/clarify without frustration.
5- 5 ½ s, “sh,” “th” (they) sp-, st-, sk-, sm-, sn-, sw-, bl-, pl-, kl- (as in clap), fl-, tr-, kr- (cracker) Approx. 100% intelligible to adults, may still have errors Child should be understood by familiar and unfamiliar listeners the majority of the time. Child should correctly produce the majority of speech sounds. Child should repeat/clarify without frustration.
6 years r, l, z, “ng” (wing), “th” (think), “ch” (check) 100% intelligible, most sounds should be mastered Child should be understood by familiar and unfamiliar listeners the majority of the time.

1Bleile, K.M. (2004). Manual of articulation and phonological disorders: Infancy through adulthood, Second edition. Clifton Park,

NY: Delmar Learning.

amazing after school snacks

Amazing After School Snacks




After a long day at school, children will certainly be hungry for a snack! Here are some recipes to try. They are simple and do not require a lot of time; your children can even help!

Red, White, and Blue Sandwich


  • 2 large whole wheat pita
  • 2 cups sliced strawberries
  • 1 cup blueberries
  • 6 tablespoons whipped cream cheese


  1. Cut the pita in half or into quarters
  2. Spread a layer of cream cheese
  3. Add strawberries and blueberries
  4. Enjoy!

Chocolate Granola Apple Wedges (perfect since we are in “apple picking season”!)


  • 2 ounces semisweet chocolate chips
  • 1/3 cup low-fat granola without raisins
  • 1-2 medium apples (some favorite kinds are: Honeycrisp, Fuji, Gala, & Braeburn)
  • Shallow dish or bowl
  • Microwave safe bowl


  1. Cut apple into wedges
  2. Place chocolate chips in microwave safe bowl—microwave for 15 seconds, stir chocolate…repeat until chips are melted
  3. Pour granola into shallow dish/bowl
  4. Dip the apple wedge in chocolate, let excess drip back into bowl
  5. Dip the chocolate wedge in the granola
  6. Refrigerate for about 5 minutes and enjoy!

Homemade Fruity Roll-Ups


  • 1 (3 oz.) pkg. INSTANT Jello—choose your favorite flavor!
  • 1/2 cup water
  • 1 1/2 cups miniature marshmallows (or 12 large marshmallows)
  • Non-stick cooking spray
  • 8” or 9” square pan
  • Whisk
  • Large microwave safe bowl
  • Dental floss


  1. Boil water in microwave (about 1 minute)
  2. Add gelatin and stir well
  3. Place back in microwave for 1 minute and stir again
  4. Add marshmallows and microwave for about 45 seconds (marshmallows should be puffed and slightly melted)
  5. Whisk together the melted marshmallows and gelatin (a creamy layer will float on the top)
  6. Lightly spray the square pan with cooking spray—make sure it is spread well!
  7. Pour mixture into pan and refrigerate for about 45 min until set and firm
  8. Loosen edges with a knife
  9. Start with one end and roll entire square up tightly
  10. Use dental floss to cut into slices (seam side down)
  11. Enjoy!

Tortilla Pizzas


  • Small corn or wheat tortillas
  • Salsa
  • Shredded cheese (cheddar and mozzarella are favorites!)
  • Foil


  1. Place foil on tray
  2. Cover tortilla with salsa
  3. Sprinkle cheese on top
  4. Cook in either a toaster oven or conventional oven until cheese melts
  5. You can try other variations by adding refried beans, chicken, beef, veggies.

Cheesy Cracker Sticks


  1. 1 ½ cups (about 4 oz.) grated cheddar cheese
  2. 4 Tbsp unsalted butter, softened and cut into 4 pieces
  3. 3/4 cup all-purpose flour
  4. 1/2 tsp coarse salt
  5. Dash of pepper
  6. 1 Tbsp milk
  7. Cutting board
  8. Rolling pin (optional)
  9. Pizza cutter
  10. Mini cookie cutters (optional)
  11. Large cookie sheet
  12. Foil


  1. Preheat oven to 350 degrees
  2. Combine cheese, butter, flour, salt, and pepper—use your hands to mix so the mixture looks like dime-size crumbs
  3. Add milk and again use your hands to form the dough into a ball
  4. Lightly flour a cutting board and roll out the dough to about 1/8-inch thickness
  5. Use the pizza cutter to cut the dough into “sticks” use cookie cutters to form shapes. Place on a foil-lined cookie sheet
  6. Bake the sticks/shapes for 10-12 minutes (or until edges are turning brown)
  7. Remove from oven and let cool
  8. Enjoy warm or at room temperature!
why hula hooping is a great exercise for kids

Why Hula Hooping is a Great Exercise for Kids




Part of my job as a pediatric physical therapist is to try to make exercises and the rehabilitation process fun for kids. Most of the physical performance measurements we use during therapy including jumping, running, and stair climbing as tools of assessment. But, I get just as excited when one of my clients learns to hula hoop for the first time, and here is why: hula hooping is a great exercise for kids!

The benefits of hula hooping for kids:

  1. Coordination – At as young as 5 years of age, children are able to break down major tasks that require coordination of every part of their body doing different motions, such as bicycling, jump roping, and hula hooping. What makes hula hooping challenging is that in order to be successful at the task, kids have to separate their trunk movements from their limbs, maintain a stable balance, and incorporate flexibility in their motions at the same time.
  2. Core strength – Performing the hula hip motion while keeping the hoop up at the trunk requires abdominal, oblique, and upper back muscle recruitment. These are big core muscles that we all need to stand and sit upright. Keeping the trunk muscles strong will help with posture, endurance, and total body coordination.
  3. Endurance – Physical fitness is so important in children and adolescence. Health-related fitness is undeniably multidimensional. Endurance itself has many components: cardiovascular, muscular, and mental. While a typically developing school-aged child should be able to remain active and play for at least 30 minutes without need for rest, so few kids these days get a chance to build on their active time outside of school. So many kids I meet can barely play for 5 minutes without being short of breath, needing to sit down, or getting frustrated by a tough physical task.
  4. Flexibility – In order to successfully keep a hula hoop up off the ground, flexibility is just as important as strength. Many kids who don’t get enough regular exercise are often stiff and uncoordinated. There’s a reason why flexibility is often on fitness tests given in schools. Parents and teachers sometimes forget flexibility is an important aspect of physical fitness. In order to ensure proper musculoskeletal development, flexibility is key. Hula hooping teaches children how to purposefully wiggle their hips, separate their two sides, gain range of motion in all their big joints, and have fun at the same time.
  5. Attention – As anyone who tries to pick up a new task knows, learning a new activity takes practice and focus. Young children who are learning something as different and challenging as the hula hoop are honing not just their physical skills but their mental fortitude as well. A task that requires coordinated movements of every part of the body requires lots of repetition to master. Having the attention and motivation to master a new physical activity will help with improved attention for school-related tasks.
  6. Confidence – Hula hooping offers many ways to expand a child’s skills set, such as moving the hula hoop up the body, performing while standing on one foot, etc. Mastery of each new skill offers children the chance to feel pride in themselves. I’ve seen children’s programs and dance competitions dedicated to hula hooping, and not a single child could stay bored or frustrated with this amusing task. There are organizations out there dedicated to introducing hula hooping to children. Nothing boosts a young child’s confidence like being able to show off new found hula hoop skills in front of her parents and friends. I have even used hula hoops as an introduction to jump rope skills.

One recent study found that today’s children are less physically fit than their parents and their endurance is on the decline. There’s a way to combat this slow onset of sedentary lifestyle for kids who aren’t so into team sports or outdoor activities. Tons of toys are out there to make physical activities seem fun, unique, and not in the least bit boring for young minds. Hula hoops are just one of many that physical therapists love to use, in order to bring out the best in little growing bodies.

Click here to view our Gross Motor Milestones Infographic!

child does not qualify for speech language services

Your Child Doesn’t Qualify for Speech-Language Services-Now What?




The start of the school year brings new school supplies, new teachers, and can bring new evaluations. Children are often flagged by doctors, teachers, or other school staff and subsequently may participate in a speech screening or possible evaluation. Following this evaluation, children may or may not qualify for ongoing speech-language services. If they don’t qualify, what do you do next?

Steps to take if your child does not qualify for needed speech-language services:

  1. If you still feel the child requires services, ask for a second opinion! If the child is told at school that he doesn’t qualify, this could be based on a child’s age or ability level. Often times the severity of a child’s difficulties may impact his qualifying for services, taking in to account age-matched peers.
  2. Watch and wait. If a child doesn’t qualify for services now, he might later! Depending on the child’s specific areas of need, articulation norms are tied to ages, so oftentimes therapists will wait until the child is in the expected age range before targeting a given sound. For example, /r/ is a later developing sound, so typically therapists won’t work on /r/ production until a child is 5 or 6 years old!
  3. Promote speech and language skills at home! Parents and siblings can be a great support for children with speech and language difficulties. Parents can model their own appropriate speech and language skills and recast if a child is struggling. When recasting, for example, parents can expand upon their child’s utterance to increase the length or make it more adult-like. If a child says, “ball,” parents can follow that with, “oh, you want the ball?” Siblings can also be a great help to work on peer interactions, turn taking, direction following and appropriate interaction and play!

Should your child not qualify for services right now – don’t give up! A licensed speech-language pathologist can help. SLPs may provide home programs to help target weak areas, and will often re-screen or even re-evaluate in 6 months or a year.

Click here for more information on our Speech-Language Pathology program.

social IQ

Tips to Raise Your Child’s Social IQ



Social IQ is a concept developed around the idea of social skills and how well-developed they are in social settings. So much awareness is involved in developing social skills: Tone of voice, facial expressions, eye contact, gestures, and personal space (just to name a few). It is amazing we learn most of them through observation alone! Where is the class that teaches us how to share, compliment, join a group, manage conflict, and express and understand feelings!?
For some kids, social skills develop naturally and without much emphasis, but for others, these can be daunting skills to tackle. With the new school year upon us, the classroom is a breeding ground for social mishaps and social victories.

If you notice your child struggles in social situations, here are some things you can do to help raise his Social IQ:

  • Get to know your child’s strengths and weaknesses: Is he flexible with his friends or does he tend to be a bit bossy?
  • Discuss with them the importance of friendships and what he thinks it means to be a ‘good friend’.
  • Set realistic social goals with your child (i.e. Lilly will congratulate two classmates if they win in a game or Johnny will introduce himself to a new classmate and ask to join in on an activity at recess.).
  • Involve teachers and counselors to help reinforce and observe goals.
  • Help your child talk about and identify feelings, facial expressions, and gestures.
  • Practice conflict management: develop a plan that’s easy to remember in ‘heated’ moments.
  • Take a deep breath, count to 3, and use “ I feel ______ when _________”.
  • Practice skills at home (i.e. sharing, complimenting, asking questions, waiting her turn to talk) and be a good role model!
  • Join a social skills group.
  • Social skills go far beyond the examples mentioned here, so this can be a great opportunity to not only learn new skills, but practice them with their peers in a structured setting.

Click here for a list of apps to help teach social skills.

mastering morning routines

Mastering Morning Routines




Many parents report the most anxiety prone time of the day is the weekday mornings. There is much going on in a very limited time. Parents often need to ensure that they are ready for work and have their children ready for school. This time of day is difficult for most children; however, children with attention problems or executive functioning weaknesses are much more prone to exhibit significant weakness with regard to their ability to follow routines and get out the door on time. Although it is difficult, it is not impossible for these children to be ready to go on time! Mastering the morning routine is the best way to get the family out the door, happily, each day.

Steps to Master the Morning Routine:

The main recommendation is to keep the mornings as structured and consistent as possible. Have the schedule planned and written out. Think about all daily routines from waking up, brushing teeth, getting dressed, to leaving the house. Think about not only the tasks that are expected of the child but also a reasonable amount of time to complete each task. It may come down to it that the list of expectations placed on the child’s morning is not realistic (today) and there might have to be some modifications.

Once it has been established that the tasks in the morning are reasonable, create a chart with picture cues for each task. Also, have the time expected for each task written down next to that item.

The first few days or weeks will require a significant amount of adult assistance to help ensure the child is finishing the tasks in the appropriate order within the required time allotments. Use strategies such as reinforcing completed tasks, timers, and praise.

Morning routines can be hectic but do not have to be impossible. With structure, organization support, and use of reinforcement, many children with attention concerns and executive functioning weaknesses are able to stay to the routine and get out the door in time.

fabulous fall crafts for families

Fabulous Fall Crafts for the Family




The shorter days and cooler nights mean fall is here!  Get into the spirit of the season with these fun fall crafts.

Fabulous Fall Crafts for the Family:

Autumn Wreath—TP (toilet paper) Style


  • Wire coat hanger
  • 14 to 16 toilet paper rolls
  • Construction paper red, orange and/or yellow (fall colors)
  • Optional: Neutral color paint like brown, yellow, or black
  • String
  • Glue or tape
  • Scissors


  1. Take each toilet paper roll and cut a slit HALFWAY through.
  2. Optional Step: If you decide to paint the rolls, do this after you cut a slit and let them dry.
  3. Bend the coat hanger to form a circle. The diameter of the completed wreath is about 15 inches.
  4. Using the slits cut halfway through the rolls, slide each of your toilet paper rolls onto the hanger to form a big circle of toilet paper rolls.
  5. Tape the toilet paper rolls together on the inside of the circle together.
  6. Cut out many, many leaf shapes from the construction paper.
  7. Optional step: children can also do “leaf rubbings” to make leaves.  To do a leaf rubbing:
  • Collect leaves from outside and place them bumpy side up on a flat surface.
  • Put a piece of white paper on top of leaves
  • Unwrap some crayons and rub over the leaf to make your rubbing.
  • Cut those rubbings out

To finish, glue the cut out leaves onto the toilet paper roll.  Tie a string at the top of the wire hanger and hang up!

Autumn Vase with flowers


  • Juice jar (750 ml)
  • Paper mache paste (1 part flour to 5 parts water… boil about 3 minutes and let cool)
  • Strips of white paper
  • Paint or markers to decorate
  • Tissue paper (fall colors: orange, red, yellow, brown AND white for center of flower)
  • Drinking straws
  • Cotton balls
  • Scissors
  • Scotch tape
  • Glue


For the vase:

  1. Paper mache the jar by dipping white strips of paper into paste. Use 3 layers to cover jar.
  2. Let jar dry for a full day
  3. Decorate the jar with paint or markers.

For the flower:

  1. Cut a square of tissue paper about 2″ by 2″.
  2. Place a ¼ of a cotton ball in the center of tissue square.
  3. Connect the cotton filled tissue paper to the end of the straw and wrap a piece of scotch tape around it to hold in place.
  4. Cut out petals from the colored tissue paper. Place 4 or 5 petals around the cotton filled tissue paper by either taping or gluing.
  5. Add at 3-4 rows of petals by layering them on top of each other until you have a nice full flower.

Marbled Salt Dough Leaves


  • 2 cups all-purpose flour
  • 1 cup salt
  • 1 cup warm water
  • Yarn/string
  • Leaf cookie cutter or template to cut shape out of dough
  • Mod podge (optional)
  • Rolling pin
  • Powdered Tempera paint (fall colors)
  • Drinking straw
  • Cookie sheet

To Make Dough: (you may want to double the recipe if there is more than one child)

  1. Combine your dry ingredients of flour and salt.
  2. Slowly add water, mixing until you have a dough-like consistency.
  3. Divide the dough into 3-4 even clumps
  4. Add powdered tempera paint (a few teaspoons until desired shade of color is reached) to each clump.

To Create Leaves:

  • Roll out colored clumps so they are about a ½ inch thick
  • Use cookie cutters or cut out your own leaf shape from the dough
  • Use a drinking straw to poke a hole in each leaf
  • Bake for about an hour at 200 degrees…remove from oven if they are turning brown!
  • Continue to let the leaves dry overnight
  • Optional: use Mod Podge to paint over leaves for a glossy finish!
  • Attach string to the hole and hang!

Arts and crafts are more than just fun.  Read here for 5 developmental benefits of arts and crafts!